The quick adoption of e-cigarettes among young users is especially alarming because experts still don’t know what long-term health outcomes may result. Because of that, no one can say for sure what will happen to young people who habitually smoke e-cigarettes, even though initial research suggests that many negative health impacts are possible.

April is Oral Cancer Awareness Month, so we’re taking a look at e-cigarettes and what existing research suggests about their impact on the mouths and throats of users.

Here are some of the health outcomes discovered so far.

Gum Inflammation

A study in Oncotarget, a peer-reviewed oncology and cancer research journal, found that flavored e-cigarettes induce gum inflammation. The study found that e-cigarette use causes a form of DNA damage that re-enforces chronic inflammation, an important contributor to the spread of oral disease.

Bone Loss, Oral Disease, and Tooth Decay

Several studies (cited below) have found connections between e-cigarette use and bone loss, oral disease, and tooth decay.

One study of 18,289 participants found that those with no history of gum disease who used e-cigarettes regularly for one year had increased odds of being diagnosed with gum disease.

Another study of 456,343 adults found an independent association—meaning the association persisted even when other risk factors were controlled—between e-cigarette use and the likelihood of having at least one permanent tooth removed because of tooth decay.

Oral Cancer

A study in the International Journal of Molecular Science compared e-cigarettes and traditional cigarettes, focusing on their impacts on the mouth at a cellular level. Broadly, this study found similarities between cigarettes and e-cigarettes when it comes to the cellular damage that has the potential to lead to oral cancer.

Additionally, other studies cited below found potent carcinogens and carcinogenic trace metals in e-cigarette vapor and the saliva of e-cigarette users.

What does all this mean?

What do we know E-cigarettes have been associated with poor oral health outcomes, from tooth decay and gum disease, to a potentially increased risk of oral cancer.

What don’t we know Without further research, oral health care experts cannot say how often poor outcomes will happen, how often an individual must use an e-cigarette to be impacted by negative health outcomes, or how severe the impacts could be.

Long-term studies must be conducted in order to obtain more representative data.

However, what we do know is important: The risk is present, and e-cigarette users must ask themselves, “Is it worth the risk?”